The English Experience
It is widely agreed that consumption of mind-altering substances creates harm in society. This is by no means the whole picture, as it is also widely agreed that taking such substances causes pleasure. In order to fully understand a thing, the Buddha insisted we must know the origin, ending, advantage, disadvantage, and escape. In future posts I will take up the question of the pleasure that drugs offer.
However for now I will look at a few indices of harm. The previous post considered the harm outside the drug-consuming country. I looked in particular in the ongoing Mexican drug wars, where hardly a day goes by without some fresh blood-soaked atrocity: another drug lord dies in a hail of bullets, a 14 year old boy admits to beheading 4 victims, women are pressed into ‘killing taxi drivers, police officers, innocent people and children’. The wikileaks cables have revealed that even the US government thinks the Mexican army has no hope of dealing with the crisis. These astonishing photos show the vast, mad wealth that flows through the criminal drug trade.
The problem is by no means limited to Mexico. In Afghanistan, wikileaks shows that efforts to eradicate the poppy trade will ‘increase the security threat’, that prosecution of high-level dealers does nothing to stem the flow, that farmers whose crops were eradicated will turn into insurgent fighters, that Government response is ‘extremely disorganized’, and that use of police for drug eradication increases police corruption and takes them away from their genuine security role. In west Africa, the key transit point for drugs for the European market, Mr. Corinne Dufka, a West African expert at Human Rights Watch observed that, “What we’re seeing is the criminalisation of the state as a result of drug trafficking.” The Executive Director of the United Nations Office on Drugs and Crime (UNODC), Antonio Maria Costa, warned that “West Africa is at risk of becoming an epicentre for drug trafficking and the crime and corruption associated with it”, and said that “This is more than a drugs problem – it is a threat to public health and security in West Africa”. Guinea-Bissau has been described as the world’s first ‘narco-state’ following its rapid and destructive takeover by the Colombian drug cartels. The corrupting effects of the drug trade, formerly in opium, now mainly in methamphetamines, has been one of the major factors in the ongoing calamity experienced by the Burmese people.
All this is the direct result of drug-consuming societies not taking responsibility for their own consumption. Rather than managing drug use in a reasonable manner, within a society that has a fairly clean and well-structured legal system, use is swept under the carpet, where it inevitably thrives in countries with the most inept, corrupt governments, creating even more chaos and destruction. As the Colombian economist Francisco Thoumi has noted in regard to the drug trade, “illegality generates competitive advantages in the countries or regions that have the weakest rule of law.”
For this post, however, I will focus on the internal harm that drug consumption causes, especially the recent developments in England.
A previous commenter has already noted the findings of David Nutt. As a regular Guardian reader, I had followed these events, and in fact this was one of the motivations for writing these series of articles. In brief, Nutt was a scientific adviser to the UK government on drugs policy. He argued that alcohol was significantly more dangerous than many illicit drugs. His list of harmful drugs at the time placed alcohol at number 5 (since revised – see below). He criticized the UK government’s current policy, arguing that it is ‘incapable of thinking logically’ on the topic.
For his troubles he was sacked, the government saying that his comments damage efforts to give the public clear messages about the dangers of drugs: “We remain determined to crack down on all illegal substances and minimise their harm to health and society as a whole.” This statement reveals the very irrationality that Nutt was highlighting: the government wants to minimize harm done by illegal substances – which obviously Nutt would agree with – but says nothing about Nutt’s actual point, which is that far more harm is done by legal substances, especially alcohol, and this harm needs to be minimized too.
The minister Alan Johnson said that it is not possible to be an adviser and critic of government policy at the same time – which, to a naive outsider, sounds like a complete denial of the very purpose of getting advice in the first place. Other scientists were shocked and some resigned in protest. Nutt went on to form his own independent committee, which came up with an even more comprehensive study, which now places alcohol at the very top of the list of dangerous drugs. The government responded by removing any legal requirement to have scientific advice in formulating drug classification policy.
Nutt’s study is apparently the most detailed of its kind, and evaluates harm to drugs from a multitude of perspectives. While acknowledging the inadequacy of any ‘objective’ attempt to assess such harm, he nevertheless came up with the following current list of harmful drugs, ranked out of 100 as follows.
Alcohol (72), heroin (55), crack (54), crystal meth (33), cocaine (27), tobacco (26), amphetamine/speed (23), cannabis (20), GHB (18), benzodiazepines (15), ketamine (15), methadone (13), butane (10), qat (9), ecstasy (9), anabolic steroids (9), LSD (7), buprenorphine (6) and magic mushrooms (5).
There are a range of effects to consider, and it is notoriously difficult to isolate the effects of one substance. Drug consumption, in any case, is not a uniform thing, and harm results from a combination of factors: the individual’s own body, the amount consumed, the motivations for taking it, what you do on the drug, what it is combined with, and so on. Typically drug use is associated with different forms of physical and mental harm, both long and short term. One statistic of obvious concern is the deaths that result from usage. In 2008 in England and Wales, there were, according to the Office of National Statistics, 897 recorded deaths from heroin, 235 from cocaine, 378 from methadone, 19 from cannabis, ‘very few’ from LSD, 44 from ecstacy; and by comparison, 8764 from alcohol. Tobacco puts all of these in the shade, with UK deaths at well over 100 000.
Nutt commented on this:
“Our findings lend support to previous work in the UK and the Netherlands, confirming that the present drug classification systems have little relation to the evidence of harm. They also accord with the conclusions of previous expert reports that aggressively targeting alcohol harm is a valid and necessary public health strategy.”
Nutt told the Lancet a new classification system “would depend on what set of harms ‘to self or others’ you are trying to reduce”. He added: “But if you take overall harm, then alcohol, heroin and crack are clearly more harmful than all others, so perhaps drugs with a score of 40 or more could be class A; 39 to 20 class B; 19-10 class C and 10 or under class D.” This would result in tobacco being labelled a class B drug alongside cocaine. Cannabis would also just make class B, rather than class C. Ecstasy and LSD would end up in the lowest drug category, D.
He was not suggesting classification was unnecessary: “We do need a classification system – we do need to regulate the ones that are very harmful to individuals like heroin and crack cocaine.” But he thought the UK could learn from the Portuguese and Dutch: “They have innovative policies which could reduce criminalisation.”
Nutt does not believe in legalizing all drugs, but he has consistently argued that our policy towards drugs should be related with the actual harm they cause. There are serious complexities here, for example, Nutt’s study focuses on the overall harm to society rather than the harm per user. This difference obviously needs to be taken into consideration. Should we spend more efforts on reducing the harm done by an intrinsically dangerous substance that is used by a small number of people, or a less dangerous substance used by many people? There’s no real ‘right’ answer. But surely, for a government that is concerned to put in place a policy that will benefit its people as a whole, it needs to focus on those issues that actually cause the greatest harm. This doesn’t mean, in and of itself, that it should legalize or change policy regarding other drugs, but it does suggest a emphasis when making decisions about how to allocate resources.
Another relevant factor is effectiveness. Something may be a major problem, but if there’s nothing that can be done about it, then there’s no point wasting resources trying. Fortunately, WHO experience shows that appropriate information, education, and enforced regulation can significantly lower alcohol use.
Another problem, noted briefly above, is that the benefits of drug use need to be considered in conjunction with their harms. But whereas drinkers of alcohol will readily claim its benefits – it’s a social lubricant, helps make and bond friendship, make you happy, gives relaxation, and so – and we demand a cost/benefit analysis in the case of medicinal drugs, there is no legitimate dialogue or acknowledgement of the benefits of illicit drug use. To do so is to to ‘send the wrong message’. Which once more assumes that those who control the message have a paternalistic right to deny others the capacity to make an informed ethical decision.
Curiously enough, Nutt’s conclusion, for all that he has been accused of trivializing the dangers of drugs, supports the UK government’s recent raising of the classification of cannabis from class C to class B. Cannabis was downgraded to class C in 2004. This change had been recommended since 1979; so it took a quarter of a century to act on this advice, but only one year later Blair proposed returning it to its class B status, which happened in 2009. This was prompted by the increasing dominance of very strong ‘skunk’ in the market.
Making cannabis class C effectively meant you can’t be charged for possession. This change freed up an estimated 199 000 police hours in the following year. The reduced burden on the public purse and the improvement in the police’s capacity to deal with other forms of crime – those with actual victims – are significant benefits of a more rational approach to drug policy.
Recent UN data shows that for the period cannabis was downgraded to class C, its use in the UK among people aged 16-24 in Britain actually fell from 28% in 1998 to 18% in 2007-08. Between 2003-2007 there was also a significant decrease in use among schoolchildren aged 15-16. Clearly, then, the decriminalization of cannabis use in the UK did not lead to an increase among young people.
It seems to me that Nutt has been scapegoated for stating the plain fact that alcohol is a far bigger scourge in society than any of the illicit drugs. This perfectly obvious truth is inadmissable. It threatens the values and lifestyles of the lawmakers, who quite like to have a pint or two after a hard day’s work. If alcohol is the real problem, they can no longer dismiss the drug problem as ‘other’.
In his justification for sacking Nutt, Alan Johnson evoked the timeless spectre: ‘There are thousands [of kids] at risk of being sucked into a world of hopeless despair through drug addiction.’ Just like there are thousands of kids ‘at risk’ of being run over by a truck. Or, more to the point, millions ‘at risk’ of becoming alcoholics, of whom there are far, far more than the number of illicit drug addicts. The WHO estimates that there are 140 million alcoholics globally, only slightly less than the total number of drug users at 185 million, of whom of course only a small percentage are addicts.
The statement that ‘kids’ are ‘at risk’ of becoming addicts is revealing on many levels. It is an emotional ploy, as we expect from politicians. But it suggests that ‘kids’ are incapable of making their own decisions and are mere helpless subjects. This is of course very far from the truth: the ‘kids’ have created and are creating an active, diverse culture in which drugs play a big role, and among themselves have a critique and understanding of drugs and their role. This is not to say that there is no problem, but it is to say that ‘kids’ are not something innocent and impotent, but are active participants and creators of the situation. As long as we think of them as children needing protection we will never understand why they take drugs in the first place – and so they’ll keep on doing it whether we make it illegal or not.
The other hypocrisy in Johnson’s statement is in the very suggestion that drug use is outside us – it is ‘the kids’ we have to worry about: whereas, of course, there are plenty of drug users in Government, in the police, in the businesses, just as there are everywhere else. The types of drugs and patterns of use will vary, but the facts can’t be denied. In every walk of life, in every government building, business center, or mall, there are people right now walking around, talking, making decisions with illicit drugs circulating in their veins. It is the embodied reality of the world we live in.
Look around you now: are you reading this in an office? (Sidebar: the stats for this site typically show increase in hits on weekdays… Just sayin’…) Some of the people you see are users, some of them probably have drugs inside them right now. Look at the people walking down the street, those on television, yes, the kids in the schoolyard – but also their teachers – or the politicians in Question Time. These are the people who we are supposed to be at war with? These are the degraded helpless victims slumped in despair in an alley? Sorry, no. These are ordinary people. For the most part, good people. People who do not deserve to be treated like criminals. Not people like you and me, but people who actually are you and me.